!"#"$%&'%!(")&*
FLUOROSCOPY DURATION IN ORTHOPEDIC SURGERY
João Caron La Salvia¹, Pablo Reis de Moraes², Tiago Yossef Ammar3, Carlos Roberto Schwartsmann4
%-.(!%)( Objective: To ascertain the mean length of radiation emission from fluoroscopic devices during several types of orthopedic surgery and which of these required greater use of radiation. Methods: The times taken to perform sixteen different types of surgery (total of 80 procedures) were measured. At the end of each procedure, the length of time for which fluoroscopy was used directly from the image intensifier was ascertained. Results: The mean time required for fluoroscopy
"$(! +,)(" $ The harmful effects of high doses of radiation in humans are well-known, including cell death and increased incidence of cancer, among others. The effects of low doses of radiation in the long term have still not been clearly established by studies on humans(1,2). In medical practice, however, it is assumed that these risks exist, and preventative measures are taken to prevent or minimize them. Thousands of orthopedic surgeries are carried out each year. Many of these require continuous use of fluoroscopy. With the advance in percutaneous techniques, locked intramedullary devices, the increasing use of radiation during these operations is noted, causing concern as to the possible harmful effects for the patient and the medical team. It is known that a fluoroscopy device can emit 0.4 rad/min, depending largely on its calibration. The majority of
per operation was 61 seconds. The procedures that demanded greatest mean duration of radiation use were bilateral proximal femoral epiphysiodesis (5.1 minutes) and femoral shaft osteosynthesis using a locked intramedullary nail (3.33 min). Conclusion: The mean duration of fluoroscopy use in orthopedic operations was 61 seconds. The procedures using an intramedullary device were the ones that required greatest radiation emission. Keywords – Radiation Dosage; Fluoroscopy; Orthopedics
the US guidelines suggest an annual limit of exposure to radiation of not more than 5 rad(1). However, the real time that the medical team and patients are exposed to radiation during the various orthopedic surgeries is not known. It is also not known which operations require more radiation emission time. Seeking to resolve these questions, the fluoroscopy usage times were determined for 80 orthopedic surgeries performed at the Sarmento Barata Surgical Center of the Hospital Santa Clara (Complexo Hospitalar Santa Casa de Porto Alegre).
/%(*!"%&'%$+'/*(0 +. From March to August 2009, the durations of 80 orthopedic surgeries performed at the abovementioned hospital were determined. All the surgical procedures were carried out using the same mobile image intensifier (Philips Endura).
1 – Resident Doctor of the Orthopedics and Traumatology Service of the Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brazil. 2 – Medical Student in the 6th year at the Universidade Federal de Rio Grande, Porto Alegre, RS, Brazil. 3 – Medical Student in the 6th year at the Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil. 4 – Full Professor of Orthopedics and Traumatology at the Fundação Faculdade Federal de Ciências Médicas de Porto Alegre and Head of the Orthopedics and Traumatology Service of the Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brazil. Work carried out at the Orthopedics and Traumatology Service of the Complexo Hospitalar Santa Casa de Porto Alegre. Correspondence: Av. Carlos Gomes, 1.111/701 – Auxiliadora – Porto Alegre, RS – 90480-004. E-mail: [email protected] Work received for publication: March 30, 2010, accepted for publication: May 24, 2010. The authors declare that they did not have any conflict of interests in producing this article. Rev Bras Ortop. 2011;46(2):136-8
© 2011 Sociedade Brasileira de Ortopedia e Traumatologia. Open access under CC BY-NC-ND license.
FLUOROSCOPY DURATION IN ORTHOPEDIC SURGERY
137
In order to determine as closely as possible the actual mean time, the surgeries were performed by various surgeons, some more experienced some less so, including resident doctors in training in Orthopedics and Traumatology at this service, working under supervision. No preference was given to any specific surgical procedure, and the surgeries were randomly selected. Sixteen different operations were analyzed, totaling 80 procedures: hip arthroscopy (four procedures); bilateral proximal femoral epiphysiodesis – cannulated screws (one); hallux valgus correction (eight); varization osteotomy of the femur (two); valgisation osteotomy of the tibia (two); osteosynthesis of the metacarpal bones – intramedullary wire fixation (seven); osteosynthesis of fracture of the distal third of the radius – plate and screws (12) – percutaneous Kirschner wires (four); osteosynthesis of fracture of the neck of the femur – canulated screws (three); osteosynthesis of transtrochanteric fracture – DHS plate (four); osteosynthesis of the scaphoid – self-compressing screw (six); osteosynthesis of the proximal humerus – angled plate (five); osteosynthesis in diaphysiary fractures of the femur – locked intramedullary nail (nine); osteosynthesis in diaphysiary fractures of the tibia – locked intramedullary nail (five); osteosynthesis of the proximal tibia - plate and screws (two); osteosynthesis of ankle fracture – plate and screws (six). The duration was recorded immediately after each
surgical procedure. The value was obtained directly from the display of the image intensifier, and reflects the exact time of radiation emitted in each procedure.
!*.,&(. Of the 80 surgical procedures performed, 44 (55%) were in male patients and 36 (45%) were in female patients. The average age of the patients was 44 years (9-91 years). The total fluoroscopy time used in the 80 surgical procedures was 4897 seconds (1 hour, 20 minutes and 31 seconds). The average was 61 seconds per procedure. The result of our study is shown in Table 1. It is emphasized that the operations that require greater use of radiation were those which used locking intramedullary device. We used, on average, 200 seconds to perform osteosynthesis of diaphysiary fracture of the femur with locked intramedullary nail (LIN) and 102 seconds to perform osteosynthesis of diaphysiary fracture of the tibia with LIN. The only case of proximal femoral epiphysiodesis with canulated screws also required significant use of radiation (310 seconds). Also of note is the low requirement for fluoroscopy in percutaneous synthesis of fractures of the neck of the femur with the use of canulated screws (less than one second of radiation emission per procedure). Also of note is the wide disparity in fluoroscopy times within a single procedure. During the femoral
(
FLUOROSCOPY DURATION IN ORTHOPEDIC SURGERY
João Caron La Salvia¹, Pablo Reis de Moraes², Tiago Yossef Ammar3, Carlos Roberto Schwartsmann4
%-.(!%)( Objective: To ascertain the mean length of radiation emission from fluoroscopic devices during several types of orthopedic surgery and which of these required greater use of radiation. Methods: The times taken to perform sixteen different types of surgery (total of 80 procedures) were measured. At the end of each procedure, the length of time for which fluoroscopy was used directly from the image intensifier was ascertained. Results: The mean time required for fluoroscopy
"$(! +,)(" $ The harmful effects of high doses of radiation in humans are well-known, including cell death and increased incidence of cancer, among others. The effects of low doses of radiation in the long term have still not been clearly established by studies on humans(1,2). In medical practice, however, it is assumed that these risks exist, and preventative measures are taken to prevent or minimize them. Thousands of orthopedic surgeries are carried out each year. Many of these require continuous use of fluoroscopy. With the advance in percutaneous techniques, locked intramedullary devices, the increasing use of radiation during these operations is noted, causing concern as to the possible harmful effects for the patient and the medical team. It is known that a fluoroscopy device can emit 0.4 rad/min, depending largely on its calibration. The majority of
per operation was 61 seconds. The procedures that demanded greatest mean duration of radiation use were bilateral proximal femoral epiphysiodesis (5.1 minutes) and femoral shaft osteosynthesis using a locked intramedullary nail (3.33 min). Conclusion: The mean duration of fluoroscopy use in orthopedic operations was 61 seconds. The procedures using an intramedullary device were the ones that required greatest radiation emission. Keywords – Radiation Dosage; Fluoroscopy; Orthopedics
the US guidelines suggest an annual limit of exposure to radiation of not more than 5 rad(1). However, the real time that the medical team and patients are exposed to radiation during the various orthopedic surgeries is not known. It is also not known which operations require more radiation emission time. Seeking to resolve these questions, the fluoroscopy usage times were determined for 80 orthopedic surgeries performed at the Sarmento Barata Surgical Center of the Hospital Santa Clara (Complexo Hospitalar Santa Casa de Porto Alegre).
/%(*!"%&'%$+'/*(0 +. From March to August 2009, the durations of 80 orthopedic surgeries performed at the abovementioned hospital were determined. All the surgical procedures were carried out using the same mobile image intensifier (Philips Endura).
1 – Resident Doctor of the Orthopedics and Traumatology Service of the Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brazil. 2 – Medical Student in the 6th year at the Universidade Federal de Rio Grande, Porto Alegre, RS, Brazil. 3 – Medical Student in the 6th year at the Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil. 4 – Full Professor of Orthopedics and Traumatology at the Fundação Faculdade Federal de Ciências Médicas de Porto Alegre and Head of the Orthopedics and Traumatology Service of the Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brazil. Work carried out at the Orthopedics and Traumatology Service of the Complexo Hospitalar Santa Casa de Porto Alegre. Correspondence: Av. Carlos Gomes, 1.111/701 – Auxiliadora – Porto Alegre, RS – 90480-004. E-mail: [email protected] Work received for publication: March 30, 2010, accepted for publication: May 24, 2010. The authors declare that they did not have any conflict of interests in producing this article. Rev Bras Ortop. 2011;46(2):136-8
© 2011 Sociedade Brasileira de Ortopedia e Traumatologia. Open access under CC BY-NC-ND license.
FLUOROSCOPY DURATION IN ORTHOPEDIC SURGERY
137
In order to determine as closely as possible the actual mean time, the surgeries were performed by various surgeons, some more experienced some less so, including resident doctors in training in Orthopedics and Traumatology at this service, working under supervision. No preference was given to any specific surgical procedure, and the surgeries were randomly selected. Sixteen different operations were analyzed, totaling 80 procedures: hip arthroscopy (four procedures); bilateral proximal femoral epiphysiodesis – cannulated screws (one); hallux valgus correction (eight); varization osteotomy of the femur (two); valgisation osteotomy of the tibia (two); osteosynthesis of the metacarpal bones – intramedullary wire fixation (seven); osteosynthesis of fracture of the distal third of the radius – plate and screws (12) – percutaneous Kirschner wires (four); osteosynthesis of fracture of the neck of the femur – canulated screws (three); osteosynthesis of transtrochanteric fracture – DHS plate (four); osteosynthesis of the scaphoid – self-compressing screw (six); osteosynthesis of the proximal humerus – angled plate (five); osteosynthesis in diaphysiary fractures of the femur – locked intramedullary nail (nine); osteosynthesis in diaphysiary fractures of the tibia – locked intramedullary nail (five); osteosynthesis of the proximal tibia - plate and screws (two); osteosynthesis of ankle fracture – plate and screws (six). The duration was recorded immediately after each
surgical procedure. The value was obtained directly from the display of the image intensifier, and reflects the exact time of radiation emitted in each procedure.
!*.,&(. Of the 80 surgical procedures performed, 44 (55%) were in male patients and 36 (45%) were in female patients. The average age of the patients was 44 years (9-91 years). The total fluoroscopy time used in the 80 surgical procedures was 4897 seconds (1 hour, 20 minutes and 31 seconds). The average was 61 seconds per procedure. The result of our study is shown in Table 1. It is emphasized that the operations that require greater use of radiation were those which used locking intramedullary device. We used, on average, 200 seconds to perform osteosynthesis of diaphysiary fracture of the femur with locked intramedullary nail (LIN) and 102 seconds to perform osteosynthesis of diaphysiary fracture of the tibia with LIN. The only case of proximal femoral epiphysiodesis with canulated screws also required significant use of radiation (310 seconds). Also of note is the low requirement for fluoroscopy in percutaneous synthesis of fractures of the neck of the femur with the use of canulated screws (less than one second of radiation emission per procedure). Also of note is the wide disparity in fluoroscopy times within a single procedure. During the femoral
(
